Trends and disparities in deep brain stimulation utilization in the United States: a Nationwide Inpatient Sample analysis from 1993 to 2017

Can Sarica; Christopher R Conner; Kazuaki Yamamoto; Andrew Yang; Jürgen Germann; Melissa M Lannon; Nardin Samuel; Michael Colditz; Brendan Santyr; Clement T Chow; Christian Iorio-Morin; David H Aguirre-Padilla; Stefan Thomas Lang; Artur Vetkas; Cletus Cheyuo; Aaron Loh; Ghazaleh Darmani; Oliver Flouty; Vanessa Milano; Michelle Paff; Mojgan Hodaie; Suneil K Kalia; Renato P Munhoz; Alfonso Fasano; Andres M Lozano

doi:10.1016/j.lana.2023.100599

Trends and disparities in deep brain stimulation utilization in the United States: a Nationwide Inpatient Sample analysis from 1993 to 2017

Lancet Reg Health Am. 2023 Sep 20:26:100599. doi: 10.1016/j.lana.2023.100599. eCollection 2023 Oct.

Authors

Can Sarica^{1

2}, Christopher R Conner¹, Kazuaki Yamamoto¹, Andrew Yang^{1

3}, Jürgen Germann¹, Melissa M Lannon³, Nardin Samuel¹, Michael Colditz¹, Brendan Santyr¹, Clement T Chow¹, Christian Iorio-Morin^{1

4}, David H Aguirre-Padilla^{1

5}, Stefan Thomas Lang¹, Artur Vetkas^{1

6}, Cletus Cheyuo¹, Aaron Loh¹, Ghazaleh Darmani², Oliver Flouty⁷, Vanessa Milano⁸, Michelle Paff⁹, Mojgan Hodaie^{1

2

10}, Suneil K Kalia^{1

2

10

11}, Renato P Munhoz^{2

12}, Alfonso Fasano^{2

10

11

12}, Andres M Lozano^{1

2

10}

Affiliations

¹ Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
² Krembil Research Institute, University Health Network, Toronto, ON, Canada.
³ Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
⁴ Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, QC, Canada.
⁵ Department of Neurosurgery, Medical School, Universidad de Chile, Santiago, Chile.
⁶ Department of Neurosurgery, Tartu University Hospital, University of Tartu, Tartu, Estonia.
⁷ Department of Neurosurgery, University of South Florida, Tampa, FL, United States.
⁸ Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, United States.
⁹ Department of Neurosurgery, University of California Irvine, Orange, CA, United States.
¹⁰ CRANIA Center for Advancing Neurotechnological Innovation to Application, University of Toronto, ON, Canada.
¹¹ KITE, University Health Network, Toronto, ON, Canada.
¹² Division of Neurology, Edmond J. Safra Program in Parkinson's Disease Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.

Abstract

Background: Deep brain stimulation (DBS) is an approved treatment option for Parkinson's Disease (PD), essential tremor (ET), dystonia, obsessive-compulsive disorder and epilepsy in the United States. There are disparities in access to DBS, and clear understanding of the contextual factors driving them is important. Previous studies aimed at understanding these factors have been limited by single indications or small cohort sizes. The aim of this study is to provide an updated and comprehensive analysis of DBS utilization for multiple indications to better understand the factors driving disparities in access.

Methods: The United States based National Inpatient Sample (NIS) database was utilized to analyze the surgical volume and trends of procedures based on indication, using relevant ICD codes. Predictors of DBS use were analyzed using a logistic regression model. DBS-implanted patients in each indication were compared based on the patient-, hospital-, and outcome-related variables.

Findings: Our analysis of 104,356 DBS discharges from 1993 to 2017 revealed that the most frequent indications for DBS were PD (67%), ET (24%), and dystonia (4%). Although the number of DBS procedures has consistently increased over the years, radiofrequency ablation utilization has significantly decreased to only a few patients per year since 2003. Negative predictors for DBS utilization in PD and ET cohorts included age increase and female sex, while African American status was a negative predictor across all cohorts. Significant differences in patient-, hospital-, and outcome-related variables between DBS indications were also determined.

Interpretation: Demographic and socioeconomic-based disparities in DBS use are evident. Although racial disparities are present across all indications, other disparities such as age, sex, wealth, and insurance status are only relevant in certain indications.

Funding: This work was supported by Alan & Susan Hudson Cornerstone Chair in Neurosurgery at University Health Network.

Keywords: Deep brain stimulation; Disparities; National Inpatient Sample; Surgical volume; Trends.